Low Arrival Rate Is Lost Revenue

By Michelle Collie, PT, DPT, MS, OCS

Most practices spend resources, time, and money on marketing to referral sources. The planned result is the physician, dentist, or office, referring patients to your practice. But how many of these referred patients actually arrive for their initial evaluation and become real, revenue-producing patients? This variable is most commonly referred to as arrival rate. And a low arrival rate is simply lost revenue and an added expense.

The goal of most practices’ marketing and public relations campaigns is to get new patients. This goal can be further defined and categorized based on the types of new patients; returning or new to the practice, payer type, referred or through direct access, social media, website, or word of mouth—the list goes on. The Healthcare Financial Management Association (HFMA) defines revenue cycle as “All administrative and clinical functions that contribute to the capture, management, and collection of patient service revenue.” Before any revenue can be captured, managed, or collected, these new patients must arrive for their first visit.

What is your practice’s arrival rate for patients scheduled for an initial evaluation that do not show? How many referrals does your practice receive via fax or electronically, but is unable to make contact with? Alternatively, after contact is made, how many patients decide not to come to physical therapy due to financial barriers, or they decide to go to another practice or seek an alternative type of provider? How many patients are referred but never contact a practice to make an appointment? All of these patients simply add to your marketing, administrative, and clinical expenses and result in lost revenue.

Establish best practices that ensure patients arrive for their first visit. There is a lot more to scheduling a patient than having a pleasant person offering convenient days and times for appointments. Scheduling staff need to understand their goal is not only to schedule a patient but also to ensure they arrive for the initial evaluation. The appropriate verbiage is required to proactively address any barriers or reasons why this patient may not arrive for their first appointment. For example: “Have you been to physical therapy before? Do you know what to expect? Would you like me to provide directions? Are there any reasons why you may not be able to come to your first appointment?” The scheduler is often the first person the new patient comes into contact with, so it is essential to have a person in this role who represents your practice well and has impeccable customer service. The scheduler must also be able to explain to the patient the value of physical therapy and address challenges from the patient who does not want to come to physical therapy despite being referred. Consider offering a free consult to the skeptical patient, or the opportunity to speak with a physical therapist. Be aware of the scheduler who describes physical therapy when asked as “exercise, massage, and dry needling.” This will drive away any patient who asks what physical therapy is! Equip schedulers with answers to questions on cost, what treatment will consist of, frequency and duration. Consider how the scheduler explains the cancellation policy. Finally, the scheduler can tell the patient who their physical therapist is and any additional information, establishing a personal connection between the patient and clinician before the first visit.

When appointments are made days in advance, consider additional reminders the day before the scheduled appointment; a text message, email reminder, or another phone call. There are many automated systems available that are separate or integrated into many EHRs (electronic health records). Alternatively, a welcome email that introduces the patient to the practice and the physical therapist they will see.

Establish what “unable to reach patient” means for your practice. One unanswered phone call to a referred patient should not result in a note being sent to the referral source stating “unable to reach patient.” What time are phone calls made and to which number? Can the referral source provide multiple ways to reach the patients? If contact cannot be made via a phone call, consider sending emails, postcards, or letters to patients’ homes.

How many patients receive a referral for physical therapy and never actually call to make an appointment? Or how often does a physician inform you they referred “lots of patients,” yet your records show one or two. Assess how every office makes their referrals and find solutions to the patient who leaves with a referral in hand but who never follows through with making an appointment. Online referral systems, faxes, and phone calls are all options to be considered. Additionally, consider the information the referral source gives to the patient. A professional and informative brochure representing your practice is more likely to result in a patient calling to schedule their initial evaluation.

Arrival rate is important to track as part of any practice’s revenue cycle management. Ongoing refinement in your practice’s processes including analyzing the data, training in best practices, and the communication of clear expectations and goals will ensure as many referrals as possible turn into real, revenue-generating patients.


Michelle Collie, PT, DPT, MS, OCS, is the chair of the PPS PR and Marketing Committee and chief executive officer of Performance Physical Therapy in Rhode Island. She can be reached at mcollie@performanceptri.com.

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